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Parasacral Ischial Plane Block in Lower Extremity Surgery

14. maj 2026 opdateret af: Nurullah Damla, Bursa Yuksek Ihtisas Training and Research Hospital

Evaluation of Sensory and Motor Blockade of Ultrasound-Guided Parasacral Ischial Plane Block in Lower Extremity Surgery

The parasacral ischial plane block is a novel fascial plane approach targeting the sacral plexus. This technique is technically less challenging and eliminates the requirement for direct visualization of the sacral plexus. The aim of this prospective observational study is to evaluate the efficacy of the conventional sacral plexus block versus the parasacral ischial plane block in patients undergoing lower extremity surgery.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Sympatholysis resulting from central neuraxial block or general anesthesia in lower extremity surgeries may lead to adverse hemodynamic changes and increased perioperative mortality, particularly in high-risk patients. In such patients, lower extremity procedures can be successfully performed solely under sciatic and femoral nerve blocks. Depending on the surgical indication, the sciatic nerve block may be utilized alone or in combination with a lumbar plexus or femoral nerve block.A novel ultrasound-guided (USG) fascial plane approach targeting the sacral plexus, termed the Parasacral Ischial Plane (PIP) block, has been successfully investigated in a limited number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium bone laterally. The piriformis muscle has no attachment to the ischium; instead, it attaches laterally to the greater trochanter. A fascial plane exists between the piriformis muscle and the ischium, which extends directly to the sacral plexus.

Venkataraju et al. stated that during the demonstration of the PIP block, the needle should be directed and positioned toward the posteromedial surface of the ischium. Following bony contact, the injectate was administered, and its spread was observed beneath the piriformis muscle toward the sacral plexus (SP). This method is considered to be technically more straightforward and carries a lower risk profile.

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

60

Fase

  • Ikke anvendelig

Kontakter og lokationer

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Studiekontakt

Undersøgelse Kontakt Backup

Studiesteder

  • Tyrkiet (Türkiye)
    • Yildirim
      • Bursa, Yildirim, Tyrkiet (Türkiye), 16300
        • Bursa High Specialization Training and Research Hospital

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  1. Ages 18-80
  2. ASA I-III
  3. Patients operated on under regional anesthesia
  4. Patients who provided written informed consent
  5. Patients scheduled for elective lower extremity surgery -

Exclusion Criteria:

  1. Patients with a history of allergy to local anesthetic drugs
  2. Patients with coagulation disorders
  3. Patients with BMI > 40 kg/m²
  4. Presence of infection at the block application site
  5. Chronic pain syndrome (chronic opioid use)
  6. Pregnant women
  7. Patients who cannot be communicated with
  8. Patients requiring emergency surgery -

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Støttende pleje
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Dobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Parasacral Ischial Plan Block

A novel ultrasound-guided fascial plane approach to the sacral plexus, called the Parasacral-Ischial Plane (PIP) block, has been successfully studied in a small number of patients. The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus.

Venkataraju et al. stated that in a PIP block demonstration, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus. This method is considered easier and less risky.
Procedure: Parasacral Ischial Plan Block

The sacral plexus is located within a fascial plane formed by the pelvic fascia anteriorly, the sacrum medially, the piriformis and gluteus maximus muscles posteriorly, and the ischium laterally. The piriformis muscle has no attachment to the ischium and attaches to the greater trochanter laterally. A fascial plane exists between the piriformis muscle and the ischium; this fascial plane extends to the sacral plexus.

Venkataraju et al. stated that in PIP block demonstrations, the needle should be directed and placed towards the posteromedial surface of the ischium. After bone contact, the medication was injected, and it was observed that the medication spread from under the piriformis muscle towards the sacral plexus.
Aktiv komparator: Sacral plexus block
This block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications.
Procedure: Sacral plexus block
This block, defined by the parasacral approach, targets the exit point of the plexus at the level of the foramen ischiadicum majus. Unlike distal sciatic blocks, blocking at this level includes the posterior cutaneous femoral nerve, superior/inferior gluteal nerve, and pudendal nerve, along with the ischial nerve. In current practice, ultrasonography (USG) has become the "gold standard"; visualizing the neural structures deep to the piriformis muscle by placing the probe between the lateral sacrum and the iliac wing increases the success rate while minimizing the risk of complications.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Sensory and motor block onset time
Tidsramme: 1 hour
This approach is based on the volume-dependent spread of local anesthetic into the plane between the sacral plexus and the deep pelvic muscle fascia; sensory blockade begins proximally to distally within 10-20 minutes, while motor blockade usually develops later and gradually around 20-30 minutes.
1 hour

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The Numerical Rating Scale (NRS)
Tidsramme: 1 Day
Pain control is a one-dimensional measurement tool, usually ranging from 0 to 10, used to subjectively assess a patient's pain intensity. In academic literature, this scale, expressed with integers from 0 (no pain) to 10 (the most severe pain imaginable), is considered a fundamental parameter for pain monitoring in clinical research and perioperative processes due to its high validity, ease of application, and flexibility in verbal or written form.
1 Day

Samarbejdspartnere og efterforskere

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Sponsor

Bursa Yuksek Ihtisas Training and Research Hospital

Efterforskere

  • Studieleder: Korgün Ökmen, Bursa Yuksek Ihtisas Training and Research Hospital

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

1. maj 2026

Primær færdiggørelse (Anslået)

1. maj 2027

Studieafslutning (Anslået)

1. maj 2027

Datoer for studieregistrering

Først indsendt

5. maj 2026

Først indsendt, der opfyldte QC-kriterier

14. maj 2026

Først opslået (Faktiske)

18. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

18. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

14. maj 2026

Sidst verificeret

1. maj 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • BursaYIERH-AR-ND-01

Plan for individuelle deltagerdata (IPD)

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INGEN

IPD-planbeskrivelse

due to patient privacy

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